Permit (79) CITY OF TIGARD MASTER PERMIT
111 Pi
• COMMUNITY DEVELOPMENT Permit#: MST2017-00124
Date Issued: 04/05/2017
TIGARD 13125 SW Hall Blvd.,Tigard OR 97223 503.718.2439 Parcel: 4/05/2 611900
Jurisdiction: Tigard
Site address: 17452 SW SHADOW TRAIL ST
Subdivision: RIVER TERRACE NORTHWEST Lot: 119
Project: River Terrace Northwest, Lot 119
Project Description: New SF
BUILDING
Floor Areas Required Setbacks Required
Stories: 3 Bedrooms: 3 First: 948 sf Basement: 799 sf Left: 3 Perking Spaces: 0
Height: 28 Bathrooms: 3 Second: 1130 sf Garage: 377 sf Front: 8 Smoke Yes
Dwelling Units: 1 Third: 0 sf Right: 3 Detectors:
Total: 2877 sf Value: $347,905.72 Rear: 10
PLUMBING
Sinks: 1 Water Closets: 3 Washing Mach: 1 Laundry Trays: 0 Rain Drain: 1 Urinals: 0
Lavatories: 4 Dishwashers: 1 Floor Drains: 0 Sewer Lines: 100 SF Rain Storm Sewer: 100
Drains: 0
Tubs/Showers: 3 Garbage Disp: 1 Water Heaters: 1 Water Lines: 100 Catch Basins: 0
Bckflw Prevntr: 0
Footing Drain: 0 Ice Maker: 1 Hose Bib: 2 Backwater Value: 1
Other Fixtures: 0
Drywell-Trench Drain: 0
Other Fixture Units:
MECHANICAL
Fuel Tvpes Air Conditioning: Y Vent Fans: 4 Clothes Dryers: 1
Natural Gas Heat Pump: N Hoods: 1 Other Units: 0
Furn<100K: 1 Vents: 0 Woodstoves: 0 Gas Outlets: 4
Furn>=100K: 0
ELECTRICAL
Residential Unit Service Feeder Temp Srvc/Feeders Branch Circuits
1000 sf or less: 1 0-200 amp: 0 0-200 amp: 0 W/Svc or Fdr: 0
Ea add'I 500 sf: 5 201-400 amp: 0 201-400 amp: 0 W/O Svc/Fdr: 0
Mfd Home/Feeder/Svc: 0 401-600 amp: 0 401-600 amp: 0
601-1000 amp: 0 601+amp-1000v: 0
1000+amp/volt: 0
ELECTRICAL-RESTRICTED ENERGY
SF Residential
Audio&Stereo: N HVAC: N Security Alarm: N Vaccuum System: N Garage Opener: N All
Other: N Other Description: Ecompasing: Y
BUILDING INFO
Class of Work: Type of Use: Type of Constr: Occupancy Group: Square Feet:
NEW SF VB R-3 2877
Owner: Contractor:
ADLV LAND HOLDINGS LLC WILLIAM LYON HOMES INC Required Items and Reports(Conditions)
BY FORSUM,MICHAEL 109 E 13TH STREET 1 Ersn Cntrl 503-639-4175
7600 E DOUBLETREE RANCH RD VANCOUVER,WA 98660 2 Fire Rated Eaves-Both
STE 1 Sides
SCOTTSDALE,AZ 85258
PHONE: PHONE: 360-695-7700
FAX:
Total Fees: $33,729.78
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable law. All work will
be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended for more the 180
days. ATTENTION: Oregon law requires you to follow the rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952-001-0010 thr.•g •°R• 2-001-0090. You may obtain a copy of the rules or direct questions to OUNC by calling 503.232.1987 or 1.800.332.2344. `/
Issued By: / Permittee Signature: CA/ '76AL /C�r/e2" "
Call 503.639.4175 by 7:00 a.m.for the next available inspection date.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
A
Building Permit Application
Ecs b>i la1
,,„.wr�.c . k 1 r FOR OFFICE USE ONLY
City of Tigard DatetSyReceived: V/9�7 Permit N°1457-020/7.--i001
q 13125 SW Iall Blvd.,Tigard,OR 9722 _
. . pPlan Revien f 11 Phone: 503.7182439 Fax; 503.598.1960 . Date/Sy: T �— 11 Other Permg
le9/7`e:AINS
TIGARD Inspection Line: 503.639.4175 t •- Date Ready/By: Juris: to See Page 2 for
Internet: www.tigard-or.gov Notified/Method: Supplemental Information
' ,5k4 3KNb.. 4. �iw: ,� ;r'o,m ,,1 . .=-0 T. t y a54W 1 ...rx,a .r' ,. fns-... >,ya^ _...gat c�. a RuCi.�r - :c.�•,y��..�.+"'��y�^,tii;
o A.,!a s,,,,Aa„'i»-G[b' k.:74,5i, � t,,., 1� '"','?; 54,,,.r,,A ;C:-3. --',a.G ,01,-4.4--4 u t F ts,1,,ar ss`570:t..x 5"4:4:' •,•! - ,,,av: P F...m'-' V&8...} i t @}ES(''t",56 .
,s,.__ � ..ai"'Nzaa, 5ar ..: b 5l'''4..'9 � ac^ rA.a,"
®New construction ❑Demolition Permit fees*are based on the value of the work performed.
Indicate the value(rounded to the nearest dollar)of all
❑Addition/alteration/replacement 0 Other: equipment,materials,labor,overhead,and the profit for the
4 ; 1 , -� r 1�u r s ; �c"^ w�� : s i �- #i aµ as „.),*•,,;.: work indicated on this application. Q 0
.,q,,S f e 2h?.r.s ° 'Six ,,"„.., a ry' 6 'w 6 6 -r r' .- ,j ••t' tyX.fi43s,z1a' •4: •
p �7
®1-and 2-family dwelling 0 Commercial/industrial Valuation:` a % !�7��-
r i
❑Accessory building 0 Multi-family Number of bedrooms: 3 3 f c p 1/451:2.
❑Master builder 0 Other: Number of bathrooms: 3
+.- c r,`S�' at5•K4,{y'S'3 n'�"{:icwsup i ��-+a7 �� xi y &n�I u..{,8u�' ,i*-,h "�0. 3
^'x', ,r•:.i i"'40.1�.! ay�",',iyt'2, '""�d'.�tp�10:10C'aaa6f C� NAPO tG N,.,,,I-na�t `t'i Total number of floors:
. ,'-� s U, .�. -'7 -ctxf' .. -s,J,a,�'�r aSfe,'r,„rF�": S5 4�... ,:x���s.�?�w�"'rYY�n ..,:.� 4.Y•
Job site address /74/5 L-. s� Yhat A] I rt.,v'c S„f New dwelling area: '11611 square feet
City/State/ZIP:Tigard,OR 97224 Garage/carport area: 3-1—) square feet i 1 3 O
Suite/bldg./apt.no.: Project name: AVerTelre`E /i ' eiii-- Covered porch area:it.) square feet q Li 13/U1
Cross street/directions to job site: 1 _ Deck area: square feet 7 Ci q
Other structure area:j . square feet
$ Ttiip4:1 ''' 4ag ci i Nem , t �
Subdivision: Ar j e e4�� _ y.(— r--
no.: l)q Permit fees*are based on the value of the work performed.i Indicate the value(rounded to the nearest dollar)of all
Tax map/parcel no.: equipment,materials,labor,overhead,and the profit for the
' 'A,ft*" 4ia ,:$1,, - e .,d t W..,rgi 7ys4 ,1: F NOW , work indicated on this application.
::.,: ;4!ursemttiwg1, ux&A�wA� ,ri r � ailc= w L ^zai.i-...
/C Pc.9 t” ,rt iLr,7- / =.Z,, Valuation: $
Existing building area: square feet
New building area: square feet
: G1 ,,1F ' ti ^xr s,'n`dr • ,04.62 'B ��;4 3"' `�" -1"3 kay se " 0i.
,,`/ #A°' . 2 ti,s 4;.;I„ ., & 7, , ,.. :t. ".f.7,43,4,,„,-,ail4,4 t 1" s 4. 4f',4 ';,4. Number of stories:
Name:ADVL Land Holdings,LLC Type of construction:
Address:7600 E Doubletree Ranch Road Occupancy groups:
City/State/ZIP:Scottsdale,AZ 85258 Existing:
Phone:(602)694.4031 Fax:( ) New:
w „ux ,�1* 't 24,41 14 4 .4w �,11�s ,s:� ii� ; d 3 P1� � o. ` .�" �W.F:Jx
Yr � �a �� .d� " SZiP.AW
?•
Business
name:Polygon WLH,LLC
Structural plan review fee(or deposit):
Contact name:Angela Grajewski
FLS plan review fee(if applicable):
Address:109 East 13'6 Street
Total fees due upon application:
City/State/ZIP:Vancouver WA 98660
Phone;(360)695-7700 Fax:;( ) Amount received:
AgiE-mail:Angela.Grajewski@polygonhomes.com t3 14,;t 1,A ra r t'pates',.:` � ` 1` i', W6t �4M.';�;
y, W ,zh?fc : M' - ht1 te ,r. ? " Commercial and residentialprescriptive
installation of
., ,,,,,,,,,,lxsttK s, {it3•,,; am.,7, nt,,,.y� �.4vo••rni,,,,L 9. ,,,? l „, to 4. s
roof-top mounted Photovoltaic Solar Panel System.
Business name:William Lyon Homes,Inc Submit two(2)sets of roof plan with connection details
and fire department access,along with the 2010 Oregon
Address: 109 East 13th Street Solar Installation Specialty Code checklist.
City/State/ZIP:Vancouver WA 98660 Permit Fee(includes plan review $180.00
and administrative fees):
Phone:(360)695-7700 Fax:(360)6934442 State surcharge(12%of permit fee): $21.60
CCB lie.:207247
Total fee due upon application: $201.60
Authorized signature: This permit application expires if a permit is not obtained
within 180 days after it has been accepted as complete.
Print name:Angela Grajewski Date:7/19/16 *Fee methodology set by Td-County Building Industry
Service Board.
I:\Building\Permits\BUP-RESPermitApp.doc 02/24/2011 440-4613T(11/02/COM/WEB)
. .
Mechanical.Peonit ApplicAtion ' For(oFFity 1.:sf:ON
.. ... , ,. . . . . . . .
City of Tigard Riteetvntt'
sh. Da13125 SW Hall Blvd..Tigard,OR 9722,3
telly.
Plan Review Pm11;14°-:t-.7....c7,70/2
:Phone: 503.718.2439 Fax: 503.598.1960 . .. Ihnctaly: Other Permit:
1.1(..,A.R.') 1 aslection Line:.503.639.4175 • . , Dale Rodyfib., hew ta Set Page 2 ter
:Internet: www.tigand-orgov NotilledivleMad: Supplemental Information
tirtW•-_,,I;..ZA.4.sk,IVA.173,..,'.,,W., ,Z5T,i3,. .1 ,it',.R.t&'''g-'..„.-7t.,!,'''' -::4141.4,,iSILL,,,,,,--.01).„„ :k-i-. Nm.,,,,
-....... ----'---,----'----'' -- ..--- '- ---.'''. - ''---- Meehartical pariah reee ate based on the valve or the work
usi New construction U Addition/alteration/replacement performed.Indieste the value(rounded to the nearest dollar)of all
• 0 Demolition 0 Other mechanical material .equipment,labor.overhead.and profit.
., ',49kttivitf- x ;:';', t,k4Value;S.h—e,,
W5...nt,tre:• -z,...4,w,-smitm... 4 afe!!..'-f.4.k.I,'
Yr].and 2-family dwelling 0 Commercial/industrial 0 Accessory building Far.04191 6iformirtkin,;tie chealisii
lulti-family 0 Master builder 0 Other: Description Qty. Ea. Total
ticow.c.,,,...:14„_‘,...*,,,•„; ..,. ....7.,.,,11,,..,.1.0.1:,,,,a,,,..,:,01i...:.,..,w-vx.i„if:#.;.,,,k;iii.,eitoto,..:::,,...,,i., ---...-.;,-, r Ileating/cmolina:
':'''*.4‘24''''' '7'2-2''''' )Lt4'-'61,..-1-"''''.v.'''' imilm, we''' •-•""'-'-'v''' '''1.-'"''''' 5:'` .... Air conditioning i 46.'75
Job silt address: 41 , -.....i .... ....NMITVIIPIMIIIIIIIII FUrtlaa 100,000 BTU(deetsiveati) I 46.75
City/State/ZIP:Tigard,OR 97223 Furnace 10(.L0001.13111(diretstvents) 34.91
Heat pump 61.06
Suite/bldg./apt,no.:
Prgieel name: 1444' r edint-' ' 0( t)uct work 23,32
Cross strcelidirections to job site: ilydronic hot water a'stem 23.32
Residential boiler(radiator or
hydronie) 23.32
Unit heaters(fuel-type,not electric),
.in-wall,induct,suspended.etc. 46.75
Flue/vent foram,of above I 23.32
. Other 23.32
Subdivision: 1? yeAr . 11 - enokkec 4— Lot no.;
Other Biel appliances;
Tax map/parcel no.:. Witter beater ; 23,32
. . -.1.,,, T-Aer- g •„ii.-„.„..',,.1.„,.,.,-;........,.. ......,--,_.,......,--„,:-...-.....4.....04k, - ,...,,,44.2,„.... , ,,,,,6:
' Flue vent for Water heater or gas
fireplace 23.32
Log
lighter
(gas) • - 23.32
Wood/pellet stove
33.39
Wood fireplace/insert fireplace/insert
23.32 --
Ch4nneY1"1141r/fluelv"t 23.32
•'".• -' '4,......4 - '---,',1'' -2---'--'''----2--'"-''.."-'-'1'-'4--- 4-''''.--"---A', -"v- - - -- Environmental exhaust auct ventilation:
Name:,Polygon Will,LLC Range hood/other kileliiii i
-... - equipment ' 33.39
AddresStreet s; 109 East 131" -
Clothes dryer exhaust / 33.39 ___
City/State/ZIP:Vancouver,WA 98660 Single-duct exhaust(bathrmuns,
toilet compartments„utility rooms) ' 2.1.32
Phone:(360)695-7700 EIIIIIIIIIIIIIIIINIMI. Aniclennvlspace fans ' 23.32
li.l..;.V,-*;: g.f.374•71*.'"1.4-F,;-:0.6r-er- 14_,,-1,1,T 4,441,4M-ViNFA:;757:1;',---i,:riper w-,
Other: 2332
..,2.,.''/....6.-7.,,WA` .-.•.,-2',.: - - ..g.1.....4.70..t-060.-71...e.tA L'.1,5tr.',,,,.4 0:4;,, :-,„,,,,. :...*_:.:1111 .4., ,-.4.,tts.:1',Zihree'
Fuel
.Business mune;Polygon W1.11„1,1C piping::
$14.15 for first four:S4.03 foe each additional,
Contact.namo:Angela Grajcwski ' Furnace.etc. /
Address:109 East 13th Street Gas heat pump .
Wallistispendedfunit heater .
City/State/ZIP:Vancouver,WA 98660 Water heater
Phone:(360)69$-7700 Fax::(360)693-4442 Fireplace I
Range I
— —
E-mail;Angtla.Grajewslzi@,polygonhomes.eoin Barbecue
MreiWalATOMC.4.WAP4t4.‘,ktUtiv,: -.4,filbt,-4,: .:t..1:1,iis,,a;:' ":,:•;.--.2aq Clol les 41 er(g") '
'°1115r-
Address:1.8004 NE 72"Ave .
Subtotal
• City/State/ZIP:Vancouver;WA 98686 Minimum permit fee(590.00)
Plan review(2S%.of permit fee)
Phone:(360342-8109 Fax:(360)326-1769— . State surchare.(12%of permit fee)
CCB tic.:203034 TOTAL Pf*MIT"FEE
.. This permit application espies:61ra permit is am.obtained within 150
• days Ant It)3X*been accepted as complete.
Authorized slgnature: . si * Fee methodology tot by Tri-Coemy nendinn indent),Sevier Renal
Prim name.. 1 g eih. 4,. Date: 1.idt./t.... 1
B.B.itaiNoro,,limmEe minitApp_040113 der 44046 IIT(11A72/COINIVE13)
Electrical Permit Application . FOR OFFICE LSE ONLY • . . . - ' .
City of Tigard . ... Received Peoltil if:f1S7-.,,o/7 -00/.2 '
. 41 13125 SW Ball Blvd.,Tigard,OR 97223 ' Datpjant,i:,
... Phone: 503.718.2439 Fax: 503,598.1960
/11111
Date/By: Related Permit g;
Inspection Line: 503.639.4175 Ready Date/By: IN= F/3 See Page 2 for
TIGAILL?z, Internet: www.tigard-orgov NotiBed/blethod: Supplemental Information
IwgrIg*--trallin,;;W:';' -,:, 1,4,is-,-.,:,Ivomramonatangemates, oto,Amessifv,•,r, ....,7,-...,i',,:iii.; 710121•110
IS:1 New construction 0 Addition/alteration/replacement Please check all that apply(submit 2 sets of plans w/items checked):
D Service or feeder 400 amps or more 0 Building over throe aides.
0 Demolition 0 Other: where the available fault current 0 Mirinas and boatyards.
W7416:Milt.,,:e.,..C,57.;,4„::,:-.Rokintojragt_ 4:01,-- ,,..ressosav,,,.z7-,,,,,.;,,•.:,;,,,,,qv exceeds 10,000 amps at 130 volts or 0 Floating buildings.
0 1-and 2-family dwelling 0 Commercial/bidtistial 0 Accessory building lees to ground,or exceeds 14,000 0 Cornmercial-use agricultural
amps for all other installations. boildings.•
CI Multi-family ,.. El Master builder 0 Other: 0 Fire pump. 0 Installation of 150 KVA or
ikfAV:tVpigttWaIgbVllXttkXFIOFM'ctkartSV,'XWif kleAliMOPPAVAIAFAVVR4 8 EmergettcY system- larger separately derived
0 AdditiOn of ew motor load of system.
Job#: Job site address:.1
t 115Z. SW"Shatiovaault Sf- 100E1P or more.
City/State/Z1P:Tigard,OR 97224 0 Six or more residential units. occupancy,
0 Health-oare facilities. 13 Recreational vehicle parks.
Suite/bldg./apt.#: Project name:River Ttrrate.. Nontwar 0 Hazardouso .
locations. El Supply voltage for more than
600 volts nominal.
El Service or feeder 600 amps r more
Cross street/directions to job site: , WaSSIONIVI-M01.4.alta, tifier4Wara
Description I Qty....c
I- Each I Total I •
New residential single-or multi-family dwelling unit.
. ..-- .
Subdivision:(4 j.(1( 1 t frace, 00v.vinv j.q+_ Lot#:t‘0 Includes attached garage.
1.000 sq.ft.°Hess 1 168.54 4
Tax map/parcel#:
Ea.addo4
l 500 sq.ft.or portin 33.92 1
riraWfatiraUt r':c...3,L•'::,4 a..:.;,, i.k,i._,.OftatrOMONtafe. _75.;..,.'-editSt ' Limited energy,re.sidtmtial 75.00 2
IA JI p — 00 tlt (with above sq.ft..)
Limited energy,multi-family
75.00 2
residential(with above sq.ft.)
,„, ,,,, Renewable Energy 0 See Page 2
6 e Pl.—;''ke.„.9."';':: aMMOR•lfriC :i'442,1CIMOM :4,—.'iXkiVets'3,3: Services or feeders installation,alteration,and/or relocation
Name:ADVL Land Holdings,LLC 200 amps or less 100.70 2
Address:7600 E Doubletree Ranch Road 201 runes to 400 amps 133.56 2
— 401 amps to 600 amps 200.34 2
City/State/ZIP:Scottsdale,AZ 85258 601 amps to 1,000 amps 301.04 2
Phone:(602)694-4031 Fax;( ) Over 1,000 amps or volts 552.26 2
' Temporary services or feeders installation,alteration,and/or
Email: •• relocation
Owner installation:This installation is being made on property that I own which is not 200 amps or less 59,36 I
intended for sale,lease,rent,or exchange,according to ORS 447,449,670,and 701. ' 201 amps to 400 amps 125.08 2
Owner signature: Date: 401 amps to 599 amps 168.54 2
. --1.41-,41+4.smt..v4, -•seRgO-A0mte,,,.,ITAR.,-6wewv,T.bisi,A2Aorgo,714,m Branch circuits-new,alteration,or extensionos panel
PITAIYMOMPOW4001rla'9'''4'''U'7147.--"" P''''" Fi'' '''' aP ,
4------'-' .-'''''' ' "'" ''''''' ''''''' '''4".-.. '''' '''''''''''4'''''--4 '''''''''' "''''''''''''"' "9"•=45- 31.4°` ' A.Pee for branch circuits wtrh i
Business name:William Lyon Homes,Inc. above service or feeder fee, 7.42 2 i
each branch circuit
Contact name:Angela Grajewski B.Fee for branch circuits without
service or feeder fee,first
Address:109 East 13th Street branch circuit 56.18 2 1
City/State/ZIP:Vancouver,WA 98660 Each add')branch circuit 7.42 2
Miscellaneous(service or feeder not included)
Phone:(360)6954700 • ' ' Fax::(360)693-4442 Each manufactured or modular
67.84 2
dwelling,service and/or feeder
Email:Angela.Grajewsid@polygonhomes.corn ,
, Reconnect only 67.84 2
451. :.5k;':',:i4V,V1-".0^1V-S:in,e670.0100- I?-V47,47,011101140,....:**111,114 Pump or irrigation circle 67,84 2
Business name:Garner Electric Washington,LLC ' Sign or outline lighting 67.84 2
Signal circuit(s)or limited-energy
Address:6101 NE St johns Rd panel,alteration,or extension. El See Page 2 2
Each additional inspection over allowable in any of the above
City/State/ZIP:Vancouver WA 98661
Additional inspection(1 hr min) 6625/hr I
Phone:(253)320-1657 Fax:( ) Investigation(1 hr min) 90.00/hr
Industrial plant(1 hr min) 78.18/hr
Email:bdaniels@gweusa.corn
Inspections for which no fee is . .
'
90.001 hr
COB Lie.: C1158 Electrical Lic.: 208174 I Suprv.Lic.: 44 4
96S specifical listed Vs iambi)
•,‘: '......". 1VISISik'•'..?1/74 '1.'-iiA•AVN:661:;".v.F.7.:A;
,, _. ..._. _....
Suprv.Electrician signature,required:Ti--21 ,
.6.ZZL.kiblz " L._ Subtotal: .1
„..
Print name: Joan P Albert ', Date: 4/26/2016 0 Plan Review Required(25%of permit fee);
` ..-- -----
State surcharge(12%of permit fee):
,,...
Authorized signatureTOTAL PERMIT FEE:
: c- `--- -- *-7----------
This permit a pplica lion expires Ira permit is not obtained within 180
Print name: Bill Daniels Date: 4/26/2016 days after It has been accepted as complete. i
* Number of inspections allowed per permit
IARtadingS.Permitsltl.CPermitApp_RI,R.ERE.doc Rev 06/17/2015 440-461sra IM/COM/WEB
.
r
Plumbing Permit Application
Building Fixtures I-OR OI ia( I. t S► O\I.1
City of Tigard Aate/By. Permit No."--As 7o20/.7't'.J/off je,
1,1 ■ 13125 SW Ball Blvd.,Tigard,OR 97223 Plan Review
ttt Phone: 503.7182439 Fax: 503.598.1960 patc/gy: Other Permit No.:
t 1 i .•c r 1> Inspection Line: 503.639.4175 p R y/13y: tuns. BJ See Page 2 for
Internet: www.tigard-or.gov Notified/Method: __Supplemental Information
....,±'S.,.:,....,.",,,, - .... :,T'I`PE.0F..WORK.„ .,., •... .' .. .. . *SCntitt),
®New construction ❑Demolition For special information use checklist
Description I Qty. I Ea. Total
❑Addition/alteration/replacement ❑Other: New 1-2-family dwellings(includes 100 ft.for each utility connection)
CATEGORY OF CONSTRUCTION SFR(1)bath 312.70
®I-and 2-family dwelling ❑Commercial/industrial SFR(2)bath 437.78
SFR(3)bath 1 500.32
❑Accessory building ❑Multi-family Each additional bath/kitchen 25.02
❑Master builder 0 Other: Fire sprinkler( sq.ft-) Page 2
JOB SITE INFORMATION'AND LOCATION Site utilities:
Job site address: I1452 'Vl 5 doW irckit 1 St Catch basin or area drain 18.76
Drywell,leach line,or trench drain 18.76
City/State/ZIP:Tigard,OR 97224
�1 Footing drain(no.linear ft.: ) Page 2
Suite/bldg./apt.no.: I Project name: giver T rm , N G�`, Manufactured home utilities 50.03
Cross street/directions to job site: Manholes 18.76
Rain drain connector 18.76
Sanitary sewer(no.linear ft.:, ) Page 2
Storm sewer(no.linear ft.: ) Page 2
f Water service(no.linear ft.: ) Page 2
Subdivision �Liq�r'TCYYAC.e. is t es - Lot no.:t 1q Fixture or item:
Tax map/parcel no.: Backflow preventer 1 31.27
DESCRIPTION OF.WORK Backwater valve 12.51
x 1
1 V15 t -,005 Dishwasher 25.02
Drinking fountain 25.02
Ejectors/sump 25.02
®.'PROPERTY OWNER I 0 TENANT Expansion tank 12.51
Name:ADVL Land Holdings,LLC Fixture/sewer cap 25.02
Floor drain/floor sink/hub 25.02
Address:7600 E Doubletree Ranch Road Garbage disposal 25.02
City/State/ZIP:Scottsdale,AZ 85258 Hose bib 25.02
Phone:(602)694-4031 Fax:( ) ice maker 12.51
b..APPLICANT . . . 0 CONTACT PERSON Interceptor/grease trap . 25.02
Business name:William Lyon Homes,Inc Medical gas(value:$, ) Page 2
Primer 12.51
Contact name:Angela Grajewski Roof drain(commercial) 12.51
Address:109 East 13th Street SinkJbasin/lavatory 25.02
City/State/ZIP:Vancouver,WA 98660 Solar units(potable water) 62.54
Phone:(360)69S-7700 Fax::(360)693-4442 Tub/shower/shower pan I2.51
E-mail:Angela.Grajewski@polygonhornes.com Urinal 25.02
{)a m
Water closet 25.02
•• CONTRAGTOR Water heater 37.52
Business name:Malmedal Enterprises Inc. Water piping/DWV 56.29
Address:PO Box 207 Other. 25.02
City/State/ZIP:Banks,OR 97106 Subtotal
Phone:(503)324-0759 Fax:(503-)324-0580 Minimum permit fee: $72.50
Plan review (25%of permit fee)
CCB Lie.:102535 PlumbingLic.no.:34-27618 State surcharge(12%of permit fee)
Authorized signature: C„.,,. TOTAL PERMIT FEE
This permit application expires it a permit is not obtained within 180 days
Print name:Carolina Malmedal Date:04/25!2016
after it has been accepted as complete.
`Fee methodology set by Tri-County Building industry Scrviee Board.
Etauilding1PermitrlPLMU•PermiIApp.doe 10(01/09 440-4616T(10/02/COM/WEB)
City of Tigard
a COMMUNITY DEVELOPMENT DEPARTMENT
illi ■
T l c A R o Building Permit Review — Residential
viormatmwesromanimasissomma
Building Permit #: /`7s j a7 / 7 - dQ/.y
Site Address: .194/SV `sctt) C4/66t0 rrij &/
Project Name: ever 7vee kir 74friez Lot #: //
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review
Proposal: A,
/eriTsite address/suite#exists and active in permit stem.
River Terrace Neighborhood: ❑ No Yes,See River Terrace Review Addendum Attached
S' Plan Elements:
ree(3)copies of site plan 1.1, I' ting structures on site
e plan must be on 8-1/2"x 11"or 11 x 17"paper II Footprint of new structure(including decks)with finished
61(
rawn to scale(standard architect or engineer scale) .or elevations
orth arrow FA tility locations(required for new,may apply for additions)
FA:rte address,project or subdivision name and lot number 113 3 . ation of wells/septic systems
.1 pplicant information(name and phone number) Illj ; ting trees to be retained with drip line,and tree
t dimensions and building setback dimensions .rotection measures
ftarea,building coverage area,percentage of coverage and eet tree size,type and location
pervious area(applicable if R-7,R-12,R-25&R-40) Vi
names
Properly corner elevations(2 foot contour lines if more than �s Tzor Co �`JZ1O
4 foot differential)
tidwIean Water Services-Service Provider Lett.((lot platted prior to 9/10/1995):
Pequired: ❑ Yes,applicant was notified LIQ No Received: El Yes ❑ No
ublic Faciliti mprovement (PFI) Permit:
quired: Yes,applicaqwas notified ❑ No Applied For: Yes ❑ No,stop intake
L7 and Use Case#: Q —0 '
-3 (PA) •
LTJ oning: —
Required Setbacks: Front Rear /0 Side _-."____> Street SideA/W-Garage 2O
gandscape Requirement:
of Coverage Maximum:
IA Building Height: Maximum Height Actual Height czOCe
Fl isual Clearance
►A asements
WI ►-nsitive Lands: ❑ Yeso Type
Yl�
Urban Forestry Plan
❑ Conditions " ,,e4"prir to issuance_ f b�1 permit /
Notes: ( ild f AG�'12 9 sS) // frt2.3"" ,Yi c>r- i i7'- /cc/ion"(
Approved By Planning: ,? Date: /
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: ❑ Approved ❑ Not Approved
I:\Building\Forms\BldgPer iitRvw_RES_091216.docx
Building Permit Submittal
Original Submittal Date: 37.7e//"7
Site Plans: # 3
Building Plans: #
Building Permit#: i]'Enter building permit#above.
Workflow Routing: ®''Planning .,2 Engineering ErPermit Coordinator + —Building
Workflow Sign-off: -2—Sign-off for Planning(include notes from planning review)
Route Application Documents: .. Engineering: (1) copy of permit application, (1) site plan, (1) building plan and
original plan review routing form.
Er-Building: original permit application, site plans,building plans,engineer and
beam calculations and trust details,if applicable,etc.
Notes: ,'�
By Permit Technician: ,C '� yt7c r�C. Date: //2
Engineering Review
Slope at building pad: /10, rte^
■ onditions "Met"prior to issuance of building permit d/ f 4T
• Easements (encroachments)per engineering conditions of approval and plat
❑ Water Quality/Quantity Facility:
Assess Water Quality Fee in-lieu: ❑ Yes ❑ No
Assess Water Quantity Fee in-lieu: ❑ Yes ❑ No
LIDA Facility on lot: ❑ Yes ❑ No
❑ NOT Approved by Engineering: Date:
Notes:
Approved by Engineering: AL 2) Date: y.../../../7
Revisions (after Building Submittal only) Reviewer Date
Revision 1: ❑ Approved ❑ Not Approved
Revision 2: ❑ Approved ❑ Not Approved
Revision 3: 0 Approved 0 Not Approved
Permit Coordinator Review
0 Conditions "Met"prior to issuance of building permit
0 Approved,NOT Released: Date:
Notes:
Revisions (after Building Submittal only)
Revision Notice 1: Date Sent to Applicant:
Revision Notice 2: Date Sent to Applicant:
Revision Notice 3: Date Sent to Applicant:
,,e
v
DC Fees Entered: Wash Co Trans Dev Tax: V, Yes /A ,,
Tigard Trans SDC: : Yes N/A
Parks SDC: ►7 Yes N/A
►:4"•K to Issue Permit
/r
Approved by Permit Coordinator: I' Date:
I:\Building\Forms\BldgPermitRvw_RES 091216.docx
IN 2 City of Tigard
COMMUNITY DEVELOPMENT DEPARTMENT
r 1 c A R D River Terrace Building Permit Review Addendum
Building Permit #: /IS i7.20 i 7 ' Cil)/.7/
Site Address: /9z `S M)J11 `71--
Project Name: /j/ver- gra Ar, ,jk,,ev.).-, Lot #: //
(New dwelling=subdivision name;Addition or Alteration=last name of owner)
Planning Review of River Terrace Plan Distri Design Standards (18.660.070.1.):
Is the project subject to the plan district design standards? es El No
1.Articulation: a minimum of 1 element per each street-facing facade that has 30-60 ft. of frontage.An additional
element required for lots with over 60 ft. of street frontage shall be provided every 30 ft.
Porch min. 5 . deep
Balcony w/access 2 Window Projection Vertical Wall Offset a
ft. deep min. 2ft., 5 ft.wide min. 2 ft., 6ft.wide Gabled dormer
CICICI ❑
2. Eyes on the street: a minimum of 12%9>f each street facing facade must include windows or entrance doors.
Percentage Shown: // 7
3. trances:At least one entrance must meet both of the follo ' g standards:
Max. 8 ft. setback from longe street- facing wall Parallel to street,angle no more than 45° from street,
or open onto porch
Entr ce opens to a porch: Yes ❑ No
If s all the following apply: sq.ft.min.
ne street facing entry ft.max.roof above floor of porch
5 ft. depth min. 30%min.porch roof coverage
4. i etailed Design:All buildings shall include a min. of five of e following elements on all street-facing façades:
12 overed porch min. 5 ft.wide x 5 ft. deep Recessed entry area min. 5 ft.wide x 2 ft. deep
all offset min. 16 inches ❑ i ormer min.4 ft.wide
Roof eave min. 12 inch projection & i .of offset min. of 2 ft.
❑ Roof shingles either tile or wood I. le,hip or gambrel roof design
❑ Roof pitch oriented south min. 500 sq. ft. orizontal lap siding min. 3-7 inches wide
CI Accent siding min. 40%of street facade Window trim min.2'/2"wide by 5/8" deep
O Window recess min. 3 inches for all street facing ❑ Bay window min. 5 ft.wide by 2 ft. deep
❑ Balcony min. 5 ft.wide x 3 ft. deep with inside access ❑ Attached garage is 35% or less of street facade
5. Garages and Carports:May face the front or side lot line on a corner lot.
Setbacks:
No oser to front or side lot line, than longest street-facing wall. ❑ Yes No. If No (Check one):
May extend upto 5 ft.if there is a covered frontporch and garage does
gar g not extend beyond the front porch.
❑ May extend up to 5 ft.where the garage is part of a two-story building and there is a window at the second story
above the garage that faces the street with a min. area of 12 sq.ft.
Width: (Check one)
❑ -foot-wide garage door El 40%max. of street facade
50%max. of street facade with 7 detailed design elements
Notes:
Approved By Planning: — - /'
r'"_"_.'"'"— ` Date:
I:\Building\Forms\BldgPermitRvw RES RT o62216.docx
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17452 SW SHADOW TRAIL ST, BEAVERTON, October 27, 2017 at
OR, 97007 1 :29:38 PM
Record Type: Record ID:
Residential - Master Permit MST2017-00124
Inspection Type: Inspector:
199 Electrical final Aaron Cillo-Gobel
Result:
PASS
Comments:
A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17452 SW SHADOW TRAIL ST, BEAVERTON, November 2, 2017 at
OR, 97007 10:13:33 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00124
Inspection Type: Inspector:
699 Mechanical final Aaron Cillo-Gobel
Result:
PASS
Comments:
A/C installed
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17452 SW SHADOW TRAIL ST, BEAVERTON, November 6, 2017 at
OR, 97007 10:19:41 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00124
Inspection Type: Inspector:
399 Plumbing final Aaron Cillo-Gobel
Result:
PASS
Comments:
Correction completed. Water pressure = 55 psi
Note: prior to building final Provide impact protection for appliances located in the garage
(ORSC M1307.3.1 )
Violation Summary:
Inspector Contractor
City of Tigard
13125 SW Hall Blvd.
Tigard, OR 97223 Tel: 503.718.2439
Location: Inspection Date:
17452 SW SHADOW TRAIL ST, BEAVERTON, November 13, 2017 at
OR, 97007 10:38:40 AM
Record Type: Record ID:
Residential - Master Permit MST2017-00124
Inspection Type: Inspector:
299 Final inspection David Young
Result:
PASS - CofO
Comments:
Corrections from previous inspection complete.
Final erosion control approved.
Street tree certification received.
Moisture content form received.
High efficiency lighting form received.
Blower door test report received.
Insulation certification checked.
C of 0 left on site with contractor.
Violation Summary:
Inspector Contractor